| NPI | 1831542711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TX 71368) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: TX 71368) |
| 101Y00000X Counselor (Licence: TX 71368) | |
| Enumeration Date | 2016-07-15 |
| Last Update Date | 2016-07-15 |